US6641571B2 - Reduction of postoperative complications of cardiopulmonary bypass (CPB) surgery - Google Patents

Reduction of postoperative complications of cardiopulmonary bypass (CPB) surgery Download PDF

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Publication number
US6641571B2
US6641571B2 US09/753,719 US75371901A US6641571B2 US 6641571 B2 US6641571 B2 US 6641571B2 US 75371901 A US75371901 A US 75371901A US 6641571 B2 US6641571 B2 US 6641571B2
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patient
surgery
cpb
taurolidine
agent
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US20020035996A1 (en
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H. Paul Redmond
Rolf W. Pfirrmann
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Ed Geistlich Soehne AG fuer Chemische Industrie
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
    • A61K31/549—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame having two or more nitrogen atoms in the same ring, e.g. hydrochlorothiazide
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P39/00—General protective or antinoxious agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P41/00—Drugs used in surgical methods, e.g. surgery adjuvants for preventing adhesion or for vitreum substitution
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/06—Antiarrhythmics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis

Definitions

  • Taurolidine bis(1,1-dioxoperhydro-1,2,4-thiadiazin-4-yl)methane has been employed as a clinically effective therapeutic agent for many years.
  • the compounds taurolidine and taurultam are as disclosed in U.S. Pat. No. 5,210,083, incorporated herein by reference.
  • Taurolidine has been utilized both for antibacterial prophylaxis and as a therapeutic bactericidal agent in peritoneal sepsis. It has a short half life and is rapidly metabolized to taurine, carbon dioxide and water.
  • Taurolidine has been shown to have a broad spectrum of antimicrobial activity against both gram positive and gram negative bacteria and fungi and has a neutralizing activity against bacterial endotoxin.
  • taurine one of the key metabolites of taurolidine, has been shown to possess significant therapeutic properties of its own including endothelial cell membrane stabilization, proinflammatory cell antiapoptotic and antioxidant capability and homeostatic cellular osmoregulation.
  • endothelial cell membrane stabilization proinflammatory cell antiapoptotic and antioxidant capability
  • homeostatic cellular osmoregulation homeostatic cellular osmoregulation.
  • taurine protects ischemic heart muscle against reperfusion induced arrhythmias, through its properties both as a membrane stabilizer and an oxygen free radical scavenger.
  • Taurolidine has been shown to be non-toxic to humans and animals and is free from side effects following intravenous and intraperitoneal administration. This wide spectrum of antiseptic properties has led to its clinical application in conditions ranging from osteomyelitis to peritonitis and catheter related sepsis prophylaxis.
  • a method of reducing postoperative complications of cardiopulmonary bypass (CPB) surgery in a patient comprises administering to the patient an effective amount of a methylol transfer agent in conjunction with CPB surgery of said patient.
  • CPB cardiopulmonary bypass
  • An additional effect is the protection from much feared infections and toxemia such as streptococci, enterococci, klebsiella, pseudomonas and serratia, inclusive of mycotic infections as candida or aspergillus, for prevention of acute myocarditis, pericarditis and endocarditis.
  • infections and toxemia such as streptococci, enterococci, klebsiella, pseudomonas and serratia, inclusive of mycotic infections as candida or aspergillus, for prevention of acute myocarditis, pericarditis and endocarditis.
  • Intraoperative dosages may be in the range of about 10-20 grams taurolidine or taurultam as active ingredient, or combination of both substances in about a 2% hypotonic solution or in about a 1% isotonic Ringer's solution as drop infusion via a central vein catheter.
  • the present invention is applicable to any suitable methylol transfer agent that reduces postoperative complications of CPB surgery in a patient.
  • the invention is further described with respect to the methylol transfer agents Taurolidine and/or Taurultam, it is to be understood that the invention is equally applicable to any suitable methylol transfer agent having activity similar to or substantially the same as Taurolidine and/or Taurultam.
  • Methylol transfer agents in accordance with the present invention can be administered in any suitable form, such as orally administered tablets or capsules, or intravenously administered solutions.
  • 250 ml of Taurolidine 2% solution is administered by intravenous infusion about 1-6 times per day, more preferably about 2-4 times per day during the treatment period.
  • One or more methylol transfer agents in accordance with the present invention can be administered before, during and/or after CPB surgery.
  • 2% Taurolidine solution is administered by intravenous infusion to a CPB patient during surgery, and the patient receives about 250 ml doses per day at about 12 hour intervals following the CPB surgery.
  • perioperative administration of the anti-endotoxins taurolidine and/or taurultam is utilized in the attenuation of the post-reperfusion sequelae in patients subjected to cardiopulmonary bypass. It is believed that the invention may affect:
  • the present invention utilizes an established non-toxic antiseptic, antiendotoxin and antioxidant agent such as taurolidine and/or taurultam in the amelioration of the post operative physiological morbidity associated with CPB surgery.
  • an established non-toxic antiseptic, antiendotoxin and antioxidant agent such as taurolidine and/or taurultam
  • the present invention utilizes perioperative taurolidine in the clinical setting of cardiac surgery to impact post-operative reperfusion induced arrhythmias, sepsis, inotropic support and in turn early mobilization and reduction in the hospital stay and improvement of clinical prognostic indicators in patients undergoing CPB with both crystalloid and blood cardioplegia techniques.
  • Aortic unclamping during cardiopulmonary bypass is the ultimate ischemia reperfusion injury and is characterized by marked derangement of the systemic inflammatory response (SIRS).
  • SIRS systemic inflammatory response
  • Taurolidine a potent anti-inflammatory antioxidant, has proven efficacy in patients with SIRS following pancreatitis. This invention shows the benefits of taurolidine treatment in patients subjected to CPB.
  • the solution is prepared with heating at approximately 60° C. with stirring in a closed stainless steel container. After cooling to room temperature, the pH is adjusted to 7.6. The solution is passed through a 0.2 and 0.1 ⁇ m sterile filter and placed in 250 mL bottles which are sterilized at 121° C. for 15 minutes.
  • the solution is prepared as in Example 1 except that 20 grams of taurolidine are added and no taurultam is added.
  • the solution is prepared with heating at approximately 60° C. with stirring in a closed stainless steel container. After cooling to room temperature, the pH is adjusted to 7.6. The solution is passed through a 0.1 and 0.1 ⁇ m sterile filter and placed into infusion bottles of 100 or 250 mL. The bottles are closed and sealed and sterilized at 121° C. for 15 minutes.
  • the solution is prepared by dissolving the components without glucose in distilled water with heating at approximately 50° C. After cooling to room temperature, the pH is adjusted to 7.2. The solution is filtered at room temperature through a 0.2 ⁇ m sterile filter into a second container with stirring into which the glucose was previously placed. The mixture is stirred briefly and filtered through a 0.1 ⁇ m sterile filter. The solution is placed into sterile glass bottles under a laminar flow hood and the bottles are closed and sealed.
  • a randomized prospective clinical trial was performed. Thirty-four consecutive patients with an ejection fraction >30%, undergoing elective coronary artery bypass grafting were randomized into four groups. Groups A and B received taurolidine (250 mL 2% taurolidine) intravenously at induction through a central line. These patients also received two further doses of taurolidine at 12 hour intervals (2 ⁇ 250 mL 2% taurolidine/day) for the first 24 hours following surgery, but in group A crystalloid cardioplegia was used for myocardial protection and in group B blood cardioplegia was used. Groups C and D received saline vehicle controls while group C had crystalloid cardioplegia and group D received blood cardioplegia.
  • Plasma samples were taken pre-operatively, at the time of aortic unclamping, 2 hours, 6 hours and 24 hours post aortic unclamping.
  • Neutrophil and monocyte respiratory burst, phagocytosis ability, CD11b and CD14 expression were assessed using flow cytometry.
  • Plasma interleukins 6, 8 and 10 IL-6, IL-8 and IL-10
  • TNF- ⁇ tumor necrosis factor ⁇
  • Patient selection was performed as follows. Patients undergoing elective coronary artery bypass grafting with an ejection fraction greater than or equal to 30%, no history of Diabetes mellitis and a normal chest x-ray were selected. Patients on ACE-inhibitors were not included in the study. The decision was made jointly by the consultant anesthetist and surgeon involved before inclusion in the study, and each patient was then randomized to drug or control. All the patients were nursed in the cardiac intensive care unit post operatively. Informed consent was sought from each patient before inclusion into the study.
  • Parameters 2-4 were assessed post aortic unclamping, 2 hours and 24 hours post-operatively.
  • Interleukin-6 was significantly down-regulated in crystalloid cardioplegia group (Group A) as compared to the blood cardioplegia group (Group B) in the taurolidine administered patients.
  • Interleukin-10 was significantly up-regulated in the crystalloid cardioplegia group (Group A) as compared to the blood cardioplegia group (Group B) in the taurolidine administered patients.
  • Administration of taurolidine in crystalloid cardioplegia patients resulted in reduced circulating IL-6 and increased IL-10 production when compared to blood cardioplegia (p ⁇ 0.05 at 24 hours post aortic unclamping). Taurolidine treatment did not appear to modify neutrophil or monocyte activity or circulating TNF- ⁇ or IL-8.
  • taurolidine may have a protective role in CPB patients subjected to crystalloid cardioplegia by up-regulating the anti-inflammatory cytokine IL-10 and down-regulating the pro-inflammatory cytokine IL-6. Based on the above results, it further appears that taurolidine may reduce arrhythmia in CPB patients.

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  • Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Pharmacology & Pharmacy (AREA)
  • General Health & Medical Sciences (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Bioinformatics & Cheminformatics (AREA)
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  • Heart & Thoracic Surgery (AREA)
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  • Urology & Nephrology (AREA)
  • Diabetes (AREA)
  • Toxicology (AREA)
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  • Rheumatology (AREA)
  • Vascular Medicine (AREA)
  • Pulmonology (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Nitrogen- Or Sulfur-Containing Heterocyclic Ring Compounds With Rings Of Six Or More Members (AREA)
  • External Artificial Organs (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Medicinal Preparation (AREA)
US09/753,719 2000-01-05 2001-01-04 Reduction of postoperative complications of cardiopulmonary bypass (CPB) surgery Expired - Lifetime US6641571B2 (en)

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JP (2) JP4819226B2 (de)
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US20080146893A1 (en) * 2006-12-13 2008-06-19 Advanced Brain Monitoring, Inc. Apnea risk evaluation system - automated prediction of risk for perioperative complications
US20100145201A1 (en) * 2006-06-14 2010-06-10 Advanced Brain Monitoring, Inc. Method for measuring central venous pressure or respiratory effort
US20100240982A1 (en) * 2009-03-17 2010-09-23 Advanced Brain Monitoring, Inc. System for the Assessment of Sleep Quality in Adults and Children
US20110132378A1 (en) * 2009-06-05 2011-06-09 Advanced Brain Monitoring, Inc. Systems and Methods For Controlling Position
US10953192B2 (en) 2017-05-18 2021-03-23 Advanced Brain Monitoring, Inc. Systems and methods for detecting and managing physiological patterns

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US20080177217A1 (en) * 2004-05-14 2008-07-24 Hans-Dietrich Polaschegg Taurolidine Formulations and Delivery: Therapeutic Treatments and Antimicrobial Protection Against Bacterial Biofilm Formation
US9220814B2 (en) * 2011-09-29 2015-12-29 Ethicon, Inc. Broad-spectrum antimicrobial compositions based on combinations of taurolidine and protamine and medical devices containing such compositions
WO2020234833A1 (en) * 2019-05-22 2020-11-26 Geistlich Pharma Ag Method for treating, preventing, inhibiting or reducing cytokine release
US20230122776A1 (en) * 2020-03-27 2023-04-20 Johannes Reinmüller Antiviral agent

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